Revisiting Weaning ! - parameters to watch in SBT
Dr. Neil MacIntyre in his recent editorial (Critical Care Medicine) 1, simply put the following 7 measurements to watch in SBT (spontaneous Breathing Trial) beside RSBI - rapid shallow breathing index - f/VT.
Objective measurements
1. Gas exchange acceptability
- Spo2 ≥85-90%,
- Po2 ≥50-60 torr,
- pH ≥7.32,
- increase in Paco2 of ≤10 torr
2. Hemodynamic stability
- heart rate <120-140>
- heart rate not changed by >20%,
- systolic blood pressure <180-200>90,
- blood pressure not changed by >20%,
- no pressors required
3. Stable ventilatory pattern e.g.,
- respiratory rate ≤30-35 breaths/min,
- respiratory rate not changed by >50%
Subjective clinical assessments
- No change in mental status (e.g., somnolence, coma, agitation, anxiety)
- No onset or worsening of discomfort
- No diaphoresis
- No signs of increased work of breathing (use of accessory respiratory muscles, thoracoabdominal paradox)
* Editorial is written in respone to article in same issue from Tobin and Jubran: Meta-analysis under the spotlight: Focused on a meta-analysis of ventilator weaning 2.
References: click to get article
1. Ventilator discontinuation process: Evidence and guidelines , Critical Care Medicine:Volume 36(1)January 2008pp 329-330
2. Meta-analysis under the spotlight: Focused on a meta-analysis of ventilator weaning , Critical Care Medicine. 36(1):1-7, January 2008. Tobin, Martin J. MD; Jubran, Amal MD
